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General NPI Number Information
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NPI Number | 1710133608
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Entity Type | Organization
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Legal Business Name | CULTIVATING CHANGE, LLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 2109 SAINT ANDREW ST STE 18
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City | TARBORO
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State | NC
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Zip | 27886-2149
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Country | US
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Telephone | 252-458-1783
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 S PITT ST
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City | FARMVILLE
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State | NC
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Zip | 27828-1884
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Country | US
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Telephone | 252-458-1783
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Fax |
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Authorized Official
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Title or Position | ORGAINZER/MEMBER
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Name | MS. DUWANDA S CONWAY
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Credential |
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Telephone | 252-458-1783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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